RESUMEN
The prophylactic use of antifungal drugs in allogeneic hematopoietic cell transplant recipients has revealed that the rate of non-albicans candidemia has increased. We herein report the case of a patient with adult T-cell leukemia who developed candidemia due to Candida fermentati during micafungin treatment after cord blood transplantation. The isolate was identified on day 47 by sequencing of the internal transcribed spacer region of the ribosomal RNA gene. The sequencing of the hot spot region of fks1p of isolate revealed naturally occurring amino acid substitutions, which conferred reduced echinocandin susceptibility. This case highlights that breakthrough candidemia due to C. fermentati occurred in a patient receiving micafungin treatment.
Asunto(s)
Antifúngicos/farmacología , Candida/fisiología , Candidemia/microbiología , Trasplante de Células Madre de Sangre del Cordón Umbilical/efectos adversos , Farmacorresistencia Fúngica/genética , Equinocandinas/farmacología , Leucemia-Linfoma de Células T del Adulto/cirugía , Lipopéptidos/farmacología , Anciano , Profilaxis Antibiótica/efectos adversos , Antifúngicos/uso terapéutico , Candida/genética , Candida/aislamiento & purificación , Catéteres Venosos Centrales/efectos adversos , Catéteres Venosos Centrales/microbiología , ADN de Hongos/aislamiento & purificación , Equinocandinas/uso terapéutico , Proteínas Fúngicas/genética , Enfermedad Injerto contra Huésped/prevención & control , Humanos , Lipopéptidos/uso terapéutico , Masculino , Micafungina , Pruebas de Sensibilidad Microbiana , Mutación , Análisis de Secuencia de ADN , Receptores de Trasplantes , Acondicionamiento Pretrasplante/efectos adversos , Acondicionamiento Pretrasplante/métodosRESUMEN
A case is presented of an eight-year-old child with a mediastinal tumour, who had developed acute renal failure following the institution of steroid therapy. Intrapleural analgesia was successfully used for the insertion of a peritoneal dialysis catheter so that the considerable risks of general anaesthesia were avoided. Subsequent dialysis allowed chemotherapy to commence and, as a result of the shrinkage in tumour size, general anaesthesia was administered safely two days later. The purpose of this report is to highlight the use of intrapleural analgesia in children as an alternative to general anaesthesia, when the latter is contraindicated. The mechanism of action of intrapleural analgesia and the risks of anaesthesia in the presence of a mediastinal tumour are discussed.